Renal denervation: Potential future implications beyond resistant hypertension

Abstract

Sympathetic nervous system (SNS) activation is a common feature of arterial hypertension and has been demonstrated to contribute to the development and progression of the hypertensive state. Persuasive evidence suggests a strong association between SNS over-activity and variety of disease states including chronic renal failure, insulin resistance, congestive heart failure, sleep apnea, ventricular arrhythmias and others. While sympatholytic agents are available to target SNS over-activity pharmacologically, they are not widely used in clinical practice leaving the SNS unopposed in many patients. The recent introduction of catheter-based renal denervation as an alternative approach to target the SNS therapeutically has been trialed primarily in patients with resistant hypertension, Preliminary data obtained from small and mostly uncontrolled studies in related disease states often characterised by over-activity of the SNS are promising but require confirmation in appropriately designed clinical trials.